A California Bill Could Totally Disrupt The Dialysis Industry

And by "total disruption," we mean making sure workers have time to clean the machines between patients.
Joe Amon via Getty Images

The bill, introduced by state Sen. Ricardo Lara (D-Bell Gardens), would do several things. It would establish minimum staffing levels, require that employees get 45 minutes to “transition between patients” ― in other words, to clean the equipment properly ― and require inspections to be conducted annually, instead of the current standard of once every six years.

California dialysis center workers and patients rallied Tuesday in a show of support for the legislation.

But Lara’s bill is opposed by a coalition of doctors, patients, and dialysis centers who claim it is redundant to existing safety measures, and who argue it will harm patients, close down centers, and make dialysis treatment harder to get.

According to a statement by the California Dialysis Council, dialysis centers already satisfy 346 federal regulations to ensure the safety of their patients and the quality of the treatments they deliver.

The bill’s opponents also point to California dialysis centers’ “report card” with Medicare. About 47 percent of the state’s clinics have 4- or 5-star ratings, while the national average is just 40 percent.

But looking at that statistic another way, it also means that 60 percent of the nation’s dialysis centers don’t score very high marks ― and that the situation in the Golden State is only a little better than in most of the U.S.

Dialysis center workers and patients rallied Tuesday behind California state Sen. Ricardo Lara's bill to set minimum staffing levels.
Mike Chavez/SEIU-UHW
Dialysis center workers and patients rallied Tuesday behind California state Sen. Ricardo Lara's bill to set minimum staffing levels.

Two companies control the marketplace

Each year, more than 63,000 Californians ― and about 468,000 people nationwide ― receive hemodialysis, the process by which a machine filters impurities from the blood when the kidneys fail.

It is clearly a big business, one created by a last-minute amendment to a Medicare bill in 1972 that in just a few paragraphs mandated coverage for dialysis for anyone who needed it. As Oliver pointed out on HBO, that makes your kidneys the only organs in your body to have universal health coverage.

Two for-profit private dialysis companies, Colorado-based DaVita Healthcare Partners and German conglomerate Fresenius Medical Care, control about 70 percent of the U.S. market. In 2015 alone, they saw a combined profit of $2.9 billion from their dialysis business. Together they operate about 3,900 locations nationwide — “roughly the same number of Target, Best Buy, and Publix Super Market stores combined,” according to The New England Journal of Medicine’s Catalyst publication last year.

For patients who need dialysis, the procedure is all that stands between them and certain death. But there is another side to dialysis ― namely, that the leading cause of death among dialysis patients has been infection, which is the impetus for the California measure.

The California bill says that low and inadequate staffing levels at dialysis centers have led to hospitalizations, medical errors, and “unnecessary and avoidable deaths.” Dialysis workers say their caseloads are too heavy, and that they sometimes feel like they’re working on a factory assembly line. They contend that there often isn’t enough time between patients to properly prepare the dialysis stations.

In one case, three patients contracted an infection at a dialysis clinic in Los Angeles County after workers didn’t adequately clean and disinfect the machines, according to a report in the American Journal of Infection Control.

As the California bill moves toward a vote by June 2, the hope is that California will serve as a model for nationwide legislation, said Sean Wherley, spokesman for the Service Employees International Union’s United Healthcare Workers West. While eight other states have established standards for dialysis care in the form of health department regulations, California would be the first state to actually legislate those minimal care standards.

Of the 468,000 people nationwide getting dialysis, 14 percent of them are in California, according to Wherley. “Once again, California is taking a leadership role in health care by developing legislation to regulate the dialysis industry,” he said. “Judging from the resistance that the dialysis industry is mounting, there is no question that this has national implications.”

CORRECTION: A previous version of this story stated there are about 650,000 patients receiving dialysis in the United States. That is the total number of patients with end stage renal failure; 468,000 of them receive dialysis.

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